Difference between revisions of "Secondary amyloidosis differential diagnosis"

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| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Primary
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| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |[[Primary amyloidosis|Primary]]
 
|Monoclonal immunoglobulin light chains
 
|Monoclonal immunoglobulin light chains
 
|50-100
 
|50-100
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| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Hereditary
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| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |[[Familial amyloidosis|Hereditary]]
 
|Transthyretin (mutated)
 
|Transthyretin (mutated)
 
|<10
 
|<10
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|25-50
 
|25-50
 
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| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |DRA (dialysis related amyloidosis)
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| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |DRA ([[dialysis related amyloidosis]])
 
|Beta‐2 microglobulin
 
|Beta‐2 microglobulin
 
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| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Senile systemic (cardiac) amyloidosis
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| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |[[Senile systemic amyloidosis|Senile systemic (cardiac) amyloidosis]]
 
|Transthyretin (wild type)
 
|Transthyretin (wild type)
 
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|50-100
 
|50-100
 
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| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Meretoja syndrome
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| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |[[Gelsolin related amyloidosis|Meretoja syndrome]]
 
|Gelsolin
 
|Gelsolin
 
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Latest revision as of 05:48, 10 November 2019

link=https://www.wikidoc.org/index.php/Secondary amyloidosis#Overview

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Syed Hassan A. Kazmi BSc, MD [2] Sahar Memar Montazerin, M.D.[3]

Overview

Secondary amyloidosis needs to be differentiated from other conditions causing nephrotic syndrome, hepatosplenomegaly, and peripheral neuropathy.

Differentiating Amyloidosis from other Diseases

Amyloisosis subtype Protein Organ involvement (%)
Kidney Liver Heart
Primary Monoclonal immunoglobulin light chains 50-100 10-25 50-100
Secondary Serum amyloid A 50-100 <10 _
Hereditary Transthyretin (mutated) <10 _ 25-50
DRA (dialysis related amyloidosis) Beta‐2 microglobulin _ _ _
Senile systemic (cardiac) amyloidosis Transthyretin (wild type) _ _ 50-100
Meretoja syndrome Gelsolin _ _ _
  • Tables below provide information on the differential diagnosis of secondary amyloidosis.
Differential diagnosis of secondary amyloidosis
Nephrotic syndrome causes[3][4][5][6][7][8][9]
Hepatosplenomegaly causes[10][11]
  • Metabolic disorders
  • Chronic liver disease and portal hypertension
  • Infectoins
  • Hematologic disorders
  • Rare disorders
Peripheral neuropathy causes[12][13][14][15][16][17][18][19][20][21][22]
  • Neurologic disorders
  • Inflammatory disorders
  • Toxins
  • Vitamin deficiencies
  • Metabolic disorders
  • Genetic disorders
Organ System Involvement Differential Diagnosis Causes Clinical Features Laboratory Findings Gold Standard Test Therapy
Nephrotic Syndrome and Renal Failure[3][4][5][6][7][8][9] Secondary (AA) Amyloidosis
  • Biopsy and congo-red staining of the sample
Primary (AL) Amyloidosis


Diabetic Nephropathy
Minimal Change Disease
Focal Segmental Glomerulosclerosis
  • Biopsy:
    • Podocyte foot process effacement
    • Capillary lumen abolished by the segmental increase in matrix
Fabry's Disease
  • Deficient alpha galactosidase A
Light Chain Deposition Disease
  • Biopsy:
    • Non-amyloid granules
Membranous Glomerulonephritis
Fibrillary-Immunotactoid Glomerulopathy
  • Biopsy:
    • Polycloncal IgG deposits
    • Infiltration of glomerular structures by amorphous acellular material (nonbranching fibrils 12-24nm in diameter)
    • Ig heavy-chain and one light-chain subclass
Organ System Involvement Differential Diagnosis Causes Clinical Features Laboratory Findings Gold Standard Test Therapy
Polyneuropathy[12][13][14][15][16][17][18][19][20][21][22] POEMS syndrome (Demyelinating)
Metabolic Syndrome (Axonal pathology)
Vitamin Deficiencies (Axonal Pathology)



Guillain-Barre Syndrome (Demyelinating)
  • Delayed F waves
  • Clinical diagnostic criteria (progressive weakness of more than two limbs, areflexia, and progression for no more than four weeks)
Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) (Mixed axonal and demyelinatiing)


  • EFNS/PNS criteria
  • Koski criteria
Multifocal Motor Neuropathy
  • Progressive, asymmetric, distal and upper limb predominant weakness
  • No significant sensory abnormalities
  • Areflexia
  • Clinical criteria (EFNS/PNS):
    • Slowly progressive or step-wise progressive, focal, asymmetric limb weakness; i.e., motor involvement in the motor nerve distribution of at least two nerves for > 1 month.
    • No objective sensory abnormalities except for minor vibration sense abnormalities in the lower limbs


Organ System Involvement Differential Diagnosis Causes Features Laboratory Findings Gold Standard Test Therapy
Organomegaly (Hepatosplenomegaly and Lymphadenopathy)[23][24] Malaria[25]
Kala-azar[26]


Infective Hepatitis
Chronic Myelogenous Leukemia (CML)[27][28]
Lymphoma
Primary (AL) Amyloidosis
  • Typical green birefringence under polarized light after Congo red staining (appears in red under normal light)
  • Congo red staining
  • Melphalan-prednisone/dexamethasone
  • Dexamethasone plus Cyclophosphamide-thalidomide
  • Stem cell transplantation
Gaucher's Disease

References

  1. Real de Asua, Diego; Galvan, Jose Maria; Filigghedu, Maria Teresa; Trujillo, Davinia; Costa, Ramon; Cadinanos, Julen (2014). "Systemic AA amyloidosis: epidemiology, diagnosis, and management". Clinical Epidemiology: 369. doi:10.2147/CLEP.S39981. ISSN 1179-1349.
  2. Mollee, P.; Renaut, P.; Gottlieb, D.; Goodman, H. (2014). "How to diagnose amyloidosis". Internal Medicine Journal. 44 (1): 7–17. doi:10.1111/imj.12288. ISSN 1444-0903.
  3. 3.0 3.1 Rivera F, López-Gómez JM, Pérez-García R (September 2004). "Clinicopathologic correlations of renal pathology in Spain". Kidney Int. 66 (3): 898–904. doi:10.1111/j.1523-1755.2004.00833.x. PMID 15327378.
  4. 4.0 4.1 Haas M, Meehan SM, Karrison TG, Spargo BH (November 1997). "Changing etiologies of unexplained adult nephrotic syndrome: a comparison of renal biopsy findings from 1976-1979 and 1995-1997". Am. J. Kidney Dis. 30 (5): 621–31. PMID 9370176.
  5. 5.0 5.1 Simon P, Ramee MP, Boulahrouz R, Stanescu C, Charasse C, Ang KS, Leonetti F, Cam G, Laruelle E, Autuly V, Rioux N (September 2004). "Epidemiologic data of primary glomerular diseases in western France". Kidney Int. 66 (3): 905–8. doi:10.1111/j.1523-1755.2004.00834.x. PMID 15327379.
  6. 6.0 6.1 Braden GL, Mulhern JG, O'Shea MH, Nash SV, Ucci AA, Germain MJ (May 2000). "Changing incidence of glomerular diseases in adults". Am. J. Kidney Dis. 35 (5): 878–83. PMID 10793022.
  7. 7.0 7.1 Malafronte P, Mastroianni-Kirsztajn G, Betônico GN, Romão JE, Alves MA, Carvalho MF, Viera Neto OM, Cadaval RA, Bérgamo RR, Woronik V, Sens YA, Marrocos MS, Barros RT (November 2006). "Paulista Registry of glomerulonephritis: 5-year data report". Nephrol. Dial. Transplant. 21 (11): 3098–105. doi:10.1093/ndt/gfl237. PMID 16968733.
  8. 8.0 8.1 Bahiense-Oliveira M, Saldanha LB, Mota EL, Penna DO, Barros RT, Romão-Junior JE (February 2004). "Primary glomerular diseases in Brazil (1979-1999): is the frequency of focal and segmental glomerulosclerosis increasing?". Clin. Nephrol. 61 (2): 90–7. PMID 14989627.
  9. 9.0 9.1 Gesualdo L, Di Palma AM, Morrone LF, Strippoli GF, Schena FP (September 2004). "The Italian experience of the national registry of renal biopsies". Kidney Int. 66 (3): 890–4. doi:10.1111/j.1523-1755.2004.00831.x. PMID 15327376.
  10. Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016
  11. Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X
  12. 12.0 12.1 Marchettini P, Lacerenza M, Mauri E, Marangoni C (2006). "Painful peripheral neuropathies". Curr Neuropharmacol. 4 (3): 175–81. PMC 2430688. PMID 18615140.
  13. 13.0 13.1 Watson JC, Dyck PJ (2015). "Peripheral Neuropathy: A Practical Approach to Diagnosis and Symptom Management". Mayo Clin Proc. 90 (7): 940–51. doi:10.1016/j.mayocp.2015.05.004. PMID 26141332.
  14. 14.0 14.1 Hughes RA (2002). "Peripheral neuropathy". BMJ. 324 (7335): 466–9. PMC 1122393. PMID 11859051.
  15. 15.0 15.1 Colloca L, Ludman T, Bouhassira D, Baron R, Dickenson AH, Yarnitsky D; et al. (2017). "Neuropathic pain". Nat Rev Dis Primers. 3: 17002. doi:10.1038/nrdp.2017.2. PMC 5371025. PMID 28205574.
  16. 16.0 16.1 Juster-Switlyk K, Smith AG (2016). "Updates in diabetic peripheral neuropathy". F1000Res. 5. doi:10.12688/f1000research.7898.1. PMC 4847561. PMID 27158461.
  17. 17.0 17.1 Bansal V, Kalita J, Misra UK (2006). "Diabetic neuropathy". Postgrad Med J. 82 (964): 95–100. doi:10.1136/pgmj.2005.036137. PMC 2596705. PMID 16461471.
  18. 18.0 18.1 Hanewinckel R, Ikram MA, Van Doorn PA (2016). "Peripheral neuropathies". Handb Clin Neurol. 138: 263–82. doi:10.1016/B978-0-12-802973-2.00015-X. PMID 27637963.
  19. 19.0 19.1 Argov Z, Mastaglia FL (1979). "Drug-induced peripheral neuropathies". Br Med J. 1 (6164): 663–6. PMC 1598252. PMID 219931.
  20. 20.0 20.1 Remiche G, Kadhim H, Maris C, Mavroudakis N (2013). "[Peripheral neuropathies, from diagnosis to treatment, review of the literature and lessons from the local experience]". Rev Med Brux. 34 (4): 211–20. PMID 24195230.
  21. 21.0 21.1 Phan T, McLeod JG, Pollard JD, Peiris O, Rohan A, Halpern JP (1995). "Peripheral neuropathy associated with simvastatin". J Neurol Neurosurg Psychiatry. 58 (5): 625–8. PMC 1073498. PMID 7745415.
  22. 22.0 22.1 Cohen JA, Gross KF (1990). "Peripheral neuropathy: causes and management in the elderly". Geriatrics. 45 (2): 21–6, 31–4. PMID 2153610.
  23. Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016
  24. Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X
  25. Malaria life cycle & pathogenesis. Malaria in Armenia. Accessed October 31, 2006.
  26. Kahan, Scott, Smith, Ellen G. In a page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:157
  27. Savage DG, Szydlo RM, Goldman JM (January 1997). "Clinical features at diagnosis in 430 patients with chronic myeloid leukaemia seen at a referral centre over a 16-year period". Br. J. Haematol. 96 (1): 111–6. PMID 9012696.
  28. Thompson PA, Kantarjian HM, Cortes JE (October 2015). "Diagnosis and Treatment of Chronic Myeloid Leukemia in 2015". Mayo Clin. Proc. 90 (10): 1440–54. doi:10.1016/j.mayocp.2015.08.010. PMC 5656269. PMID 26434969.

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